LEIDEN, The Netherlands— 'Tis the season for flu shots, and this also applies to patients with autoimmune diseases who are on anti-tumor necrosis factor alpha (TNF-α) therapy, according to new research published online in the Annals of Rheumatic Diseases.¹

"The present study demonstrates adequate protection rates against influenza in patients treated with anti-TNF despite lower postvaccination antibody titers and lower response rates as compared with both similar patients not treated with anti-TNF and healthy controls," conclude the study authors led by L. B. S. Gelinck, MD, of the department of infectious disease at Leiden University Medical Center in The Netherlands.

Researchers measured the antibody response to influenza vaccination in 112 patients with longstanding rheumatoid arthritis (RA) or Crohn's disease who were treated with immunosuppressive medication, including 64 patients treated with a TNF-blocker and 48 patients not taking a TNF-inhibitor; 18 healthy individuals served as controls.

Findings support current guidelines

The proportion of individuals with a protective titer (>e;40) after vaccination ranged from 80% to 94% and did not significantly differ between the three groups. Postvaccination geometric mean antibody titers against influenza (A/H3N2 and B) were significantly lower in the 64 patients treated with anti-TNF drugs compared with the 48 patients not receiving anti-TNF and the healthy controls. The antibody response to influenza vaccination in patients treated with anti-TNF is only modestly impaired and is not clinically relevant.

"The proportion of patients with protective titers after a single vaccine dose is substantial, about 80%, irrespective of the immunosuppressive medication or underlying condition," they write. "This endorses the current guideline for a single annual influenza vaccination of these patients, including those treated with anti-TNF."

Experts urge flu shots for patients on TNF-blockers

"The article shows that people on anti-TNF drugs have a good response to the flu vaccine—almost as good as people not on the drug," said E. Neil Schachter, MD, professor of medicine and community medicine and the medical director of the respiratory care department at the Mount Sinai Medical Center, in New York City. "People with RA and on anti-TNF drugs are actually at higher risk for both catching the flu as well as complications from the flu, and should definitely get the flu shot," he told Musculoskeletal Report. "For extra protection, their family members should also be immunized to further reduce risk of the flu."

Calling the new findings "reassuring to those of us who have been recommending vaccinations for our RA patients," Martin Jan Bergman, MD, chief of rheumatology at Taylor Hospital, in Ridley Park, Pennsylvania, said that "patients with RA are at increased risk of infections including respiratory tract infections [and] anything to decrease the risk of them getting a serious infection, or a secondary bacterial infection after a viral one, seems like a good idea to me. I am also very careful to advise patients on any immunosuppressant to avoid getting the live virus nasal vaccine and advise close family members to avoid that particular vaccine, as well," Dr. Bergman said.

"Although patients on an anti-TNF medication may have statistically lower titers than patients on other DMARDs or controls, this is not a clinically relevant finding, they still get adequate protective responses which is, ultimately, more important."

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